Toothbrushing, again.

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I've posted about this before, but we've kinda hit a tipping point and I need some advice.

Toothbrushing. Youngest is 3 1/2, non-verbal, and refuses to brush his teeth. Because of this (and his refusal to drink milk surely doesn't help) his teeth are in pretty bad shape, and he's going to have to get knocked out next week so that he can have four cavities filled.

We can, barely, afford this. The charge for the board that they strap him to is the worst, and most inexplicable part...but never mind that. Point is, we don't like the though of his having to be sedated in the first place, and we'd rather this wasn't necessary.

So, for the past few months, we've been brushing his teeth for him. I hold him, his mom brushes, he screams and cries until it's over then gives Mom a big kiss and goes straight to bed. Youngest being a bundle of contradictions, he would insist upon the toothbrushing, and then run and hide behind the bathroom door so that I had to come and get him.

Last week, while thrashing, he jerked his head forward and the brush must have got the back of his throat. He threw up, all over his beloved lovey "Spooky", which he sleeps with every night. Separating him from Spooky was more traumatic for him than the actual vomiting, I think.

Since then, the screaming and struggling has been worse. Tonight, he vomited again. Toothbrushing just isn't working, and we can't continue to traumatize him.

What else can we do? I'm going to look into a chewable toothbrush, and into those things for babies that you slip over your finger...but I don't know how either of those will work. Are there other alternatives? What have you done with a kid who refuses to brush? I'm not willing to let it go; I've suffered from my own poor dental habits, and frankly we can't afford to keep going to the dentist for sedated procedures.

Don't know if this is relevant at all to your situation, but I had major issues with mint, toothpaste always felt like it was burning my mouth. My mum found a raspberry flavored toothpaste that was much more acceptable.

I have found that Aspies can be very reasonable if you explain things to them straight. We have always being very direct and honest with our daughter, and we have asked for her help when needed, and she always behaves when she understands the reasons. Explain to your kid the consequences of not brusing his teeth. You can use pictures of broken teeth to support your explanation, show him what will happen if he does not brus his teeth (you can also use the dentist experience to support your argument, I bet he will hate the dentist more than brushing his teeth). Also try to make the tooth brusing moment a good moment through a good rutine. You can play music, sing a song (I used to sing one to me little girl), he can brush the teeth of his toys (a plastic toy, just in case) while you brush his teeth, etc. Make sure to choose a tooth paste he likes (if possible, my daughter doesnt like any), and use a very soft tooth brush. I've heard about a paste that desensibilize his gums, you can ask the dentist about it. Maybe that could help. My daughter did not like milk either, but his doctor told me we could give her other dairy products to compensate. We gave her yogurt, cheese, and I included milk in her food as much as possible (smoothies, ice cream, creams, oats, etc). He needs to avoid candies and gum as possible. I hope it helps.

Show him pictures of gum disease and walk him thru the "toothless" neighborhoods (every town has one) and show him what happens if he doesn't brush. Take him to visit gramma and have her pull out her dentures and show him the paste he'd have to use...
Sure he's just a little kid and this might sound harsh but it might be something to keep in mind longterm. Trust me you want to teach him this before he starts getting his adult teeth.
I wish (in retrospect) my parents had been harsher with me when I was young.

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Okay.. On a more reasonable level: Maybe he needs to get comfortable with the toothbrush. Buy one of those plastic travel covers for it and when not in use, have a special place in his bedroom where it stays. Let him carry it to the bathroom when it's toothbrushing time. Make a ritual out of the toothbrush. Make it personal and "holy". Also reduce the number of brushings to once a day (for now) and thus fewer struggles relating to it each day and thus fewer bad associations and stresses re: brushing. Buy different flavors (already suggested) and let him taste test and choose... maybe let him choose his toothbrush at the store too. Give him more control over those things that don't matter, and he may be less inclined to fight the battle.

I would find a tooth paste that is NOT mint flavored if that is what you are using though you probably aren't, as that can severely burn a hypersensitive child's mouth. I would also find the softest toothbrush you can and see if you can get him to try brushing his own teeth with it.

I know my oral hygiene as a toddler was not the greatest as I frequently had to be held down as well, however I didn't actually develop any cavities in my baby teeth. Genetically good enamel was not the reason, as it really isn't all that great, so I believe what inhibited cavities was my diet.

The only thing my mother ever gave me to drink when I was young was water, milk, and the occasional juice. She did not buy sugary cereal and it never got junkier than Honey Nut Cheerios. She usually gave us celery and cream cheese, or cheese and apples for a snack instead of crackers....crackers will cause a film of bacteria to develop on the teeth very quickly. So basically, the diet just wasn't the most conductive to supporting the proliferation of bacteria that produces cavity causing waste.

The toothpaste -- some berry-flavored non-fluoride stuff -- is the one thing that I'm sure isn't a problem. If I put it on a brush and give it to him, he'll happily suck it off and ask for more....

It's the physical act of brushing that he hates, and he's just not old enough to be reasoned with. He's doesn't seem to be grasping abstract concepts at this point. If he is, he's not giving any sign of it.

(He's very good at asking for things, using clearly articulated words. Conversations, on the other hand, are steams of high-speed babble that may or may not be English. It's hard to tell.)

Youngest's diet needs work, but there we're running up against his picky eating. We're a bit shell-shocked because of his "Failure to Thrive" diagnosis when he was a baby, which we eventually traced to a nasty case of acid reflux caused by his laryngomalacia. Even now he picks and grazes all day, to the point where we're delighted to see him actually eating something.

I really wish we hadn't lose the instruction manual for this kid....

You know? I've heard this tons of times before. I have never found a kid you cannot reason with. Yes, I have found stubborn kids (my child is one of those), but even with those you can reason if you talk to them in the right way. I think parents do not give enough credit to their children. Even babies understand what you say. Maybe they cannot always perform what you ask, because of developmental stage, but most of the time they DO understand. I've found a lot of mothers saying the same thing you do, and when I try to talk to they children they do understand and they do deliver (if requested reasonable things to their stage). If you find you cannot reason with him, maybe you can ask somebody else (sometimes they react better to someone that's NOT their parents), like the dentist or his therapist (if he has one - if he doesn't, he should). I do agree with Chronos that diet is very important. I restricted my kid's intake of sugar, added more veggies and fruits to her diet (she could only stand about 3 fruits and 3 veggies, all raw, so I gave her the those). And I never gave up. It was hard, really hard, because she did a problem out of everything: bathing, eating, brushing her teeth, brushing her hair, cutting her hair, cutting her nails, picking up her toys, etc., etc., etc., but I never gave up. Sometimes I am glad I did not find out she had AS until she was 9, because, as I did not know, I always pushed, I always tried, and she succeeded in a lot of things. Maybe as you DO now you will not try because you do not want to hurt him and you know it is caused by AS. As I found out that late I never take AS as an excuse for not doing anything (and believe me, my daughter has tried to use AS as an excuse several times). I tell her I know it is hard for her, but not impossible, and I push her to do what is difficult for her. My husband also has AS and he supports my approach, he says she wished his mother had done the same for him.

Oh, don't get me wrong -- when I talk to him, I'm doing so with the assumption that he understands every single word. With the toothbrushing, I've tried talking, demonstrating, using his brother as an example, DVDs, books, and (god help me) puppets. None of it has caused him to budge, in any way shape or form. The barrier is coming in with his inability (or disinclination) to give me any feedback.

For all I know, he understands perfectly...but just doesn't care. He's three and a half; that's not even remotely implausible.

Tonight, I decided on a different tack. I put paste on the brush, and just handed it to him. No more forced brushing, at least for now.

And what did he do, after licking the paste off? Very gently, and almost certainly ineffectually, scrub back and forth across his upper front teeth.

I applauded, cheered, gave him high-fives. He smiled a little, and asked for more paste.

I'll do this again for the next week or so, and then try shaking things up a little bit at a time.

Those are great news! I am so glad! Maybe you can print a diagram he can follow indicating the spots he needs to brush (my daughter used to brush only the front teeth but forgot the rest). Aspies are not good following directions or being told what to do. He needs to feel he is doing this because he wants to, appropriate the idea tha HE is the one who decided to brush his teeth because HE wants to. I am sure you can find the way to make him feel that way.

I just had a thought.....depending on hoe you feel about dyes.

Have you deen the chewable red tablets that color the plaque on your teeth red? This is used as a guide for children to see how to brush their teeth. Well what about you chewing one of the tablets, and letting him brush the red off ofnyour teeth. It may be fun enough to hold his interest. Then if he likes it, he can do his own teeth.

There are also drops for this.

My DS is 11 and still fussed with me about teeth brushing.

I'm not sure what to do about this, either. Boo is 14, was never to the dentist before I took him when he was 12, which of course I didn't know, but that's another story in itself. When I did take him, he had to be put under for dental surgery as well. I believe they ended up removing 2 teeth, filling 3 or 4 cavities, and something else that I can't quite remember. I know electric toothbrushes help for him because they will do a lot of the work for him instead of him having to brush hard, which is what bothers him so much. He doesn't seem to have an issue with the toothpaste, as he is verbal, but it's primarily a sensory issue for him. I constantly remind him of the dental surgery, but it doesn't seem to bother him, so I'm not sure how much it would help explaining the situation. For a child that young I would suggest only what you mentioned which is the toothbrush that you put over your finger. I'm not sure what else you could do.

That's a fantastic idea -- I'd tried something similar with Eldest, using this "Secret Agent Blue" rinse, but the blue was so faint that it was almost impossible to make it out. If those tablets still exist (I remember them vividly from my own time in grade school), they would be perfect for him. Don't know how it would work for Youngest, as they'd have to be pretty tasty for him to consent to chewing on one.

Eldest does brush, but only very reluctantly -- he, too, has a lot of dental work to be done, compounded by adult teeth coming in in FRONT of his baby teeth, so that he's going to have a few pulled. Those red tablets would be fantastic for him.

They tried doing Eldest's dental work last month, but he flipped out in the chair and we've got him tentatively scheduled for a sedated session at the end of September. He was fine the last time he had to have teeth drilled, but this time they convinced his mother to let him go back alone. It didn't go well.

We're giving it another shot, though, with me by his side the whole time. I really hope it works out, although I know that he's not going to enjoy it. At all.

[i][i]You know? I've heard this tons of times before. I have never found a kid you cannot reason with. Yes, I have found stubborn kids (my child is one of those), but even with those you can reason if you talk to them in the right way. I think parents do not give enough credit to their children. Even babies understand what you say. Maybe they cannot always perform what you ask, because of developmental stage, but most of the time they DO understand. I've found a lot of mothers saying the same thing you do, and when I try to talk to they children they do understand and they do deliver (if requested reasonable things to their stage). If you find you cannot reason with him, maybe you can ask somebody else (sometimes they react better to someone that's NOT their parents), like the dentist or his therapist (if he has one - if he doesn't, he should). [/i][/i]

Seriously? He's 3 and a half and non-verbal! I don't think the problem is that he's stubborn, more than likely he doesn't understand first/then or if/then concepts, which does make it really difficult to reason with. Maybe you could try a social story or a visual schedule? My little girl with classic autism is 4.5 and we've been working on brushing on her own for over 2 years. I got a 'tooth tunes' toothbrush (you can find them on ebay) and it really helped with my daughter's anxiety around brushing. It has a little speaker in the head of the brush that plays a song and you hear the song best when the toothrush is in your mounth. I think it works on 2 levels, the music helps to relax her during the brushing, and the song is exactly 2 minutes long, so after a few times she was better able to anticipate when the brushing would be over, reducing her anxiety. We started of holding her down on her bed while we brushed(because she would fight it so bad), then moved to standing in the bathroom and brushing (while holding her), then standing without being held, now we take turns I do the initial brushing, then once its done and I know the teeth are clean, then she gets a turn to brush herself. Hopefully she'll be ready to brush on her own, but honestly we're not even close yet.

Good luck!

Dear Brooke, Rolzup never said the kid is non-verbal. She said, actually "He's very good at asking for things, using clearly articulated words.", so he is verbal. And I am not saying he's being stubborn, just that sometimes when they fully understand the consequences or their actions they are more prompt to stand a little pain because they know if they dont what the consequences are gonna be. It worked for us with our little Aspie, and my Aspie husband always insistec in explaining everything to her until she fully understood the consequences. I think it works. It does not work all the time, but in our case it helped about 50% of the time, do its worth trying.

Your advise is great. I am sure it will help Rolzup. And I congratulate you for being such a good mother. Some people will just stop trying because it is too complicated or hurtful. You keep on trying. That is admirable. At the beginning I thought it was nothing special and that all mothers would do the same for their kids, but then I realized thats not true and actually we are just a few.

Last edited by Ilka on 23 Aug 2011, 9:46 am, edited 1 time in total.

Well. You said the little one needs 4 fillings right?

It's bound to be an unpleasant experience.
Make sure you teach the connection between failing to brush and getting the drill.
That connection should make headway if nothing else.

Unfortunately cause and effect can be difficult to teach when it comes to a negative. For instance it's easy to prove when people are in my mouth, it hurts. Difficult to prove, staying out of my mouth hurts in the long run. Often kids have trouble with the abstract of something you don't do, over time being connected to any single moment or experience.

BTW - I have found both colored drops and the tablets in the tooth care section of Target. The drops are easier to manage, and they're kind of fun. They don't taste great but not bad either.